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A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti\u2010inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented.<\/jats:p>","DOI":"10.1016\/j.arthro.2014.11.045","type":"journal-article","created":{"date-parts":[[2015,2,11]],"date-time":"2015-02-11T08:32:07Z","timestamp":1423643527000},"page":"715-718","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["Biological Methods to Enhance Bone Healing and Fracture Repair"],"prefix":"10.1002","volume":"31","author":[{"given":"Ren\u00e9","family":"Verdonk","sequence":"first","affiliation":[{"name":"Gent State University Gent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannick","family":"Goubau","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology University Hospital Gent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik 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